S.C. Code Regs. § ch. 69, 69-44, app E
Long Term Care Insurance
For the State of __________
For the Reporting Year of __________
Company Name: __________Due: June 30 annually
Company Address: ___ ___
Company NAIC Number: ___
Contact Person: __________Phone Number: __________
Line of Business: Individual Group
Instructions
The purpose of this form is to report all long term care claim denials under in force long term care insurance policies. "Denied" means a claim that is not paid for any reason other than for claims not paid for failure to meet the waiting period or because of an applicable preexisting condition.
State Data | Nationwide Data [FN1] | |
1 Total Number of Long Term Care Claims Reported | ||
2 Total Number of Long Term Care Claims Denied/Not Paid | ||
3 Number of Claims Not Paid due to Preexisting Condition Exclusion | ||
4 Number of Claims Not Paid due to Waiting (Elimination) Period Not Met | ||
5 Net Number of Long Term Care Claims Denied for Reporting Purposes (Line 2 Minus Line 3 Minus Line 4) | ||
6 Percentage of Long Term Care Claims Denied of Those Reported (Line 5 Divided By Line 1) | ||
7 Number of Long Term Care Claim Denied due to: | ||
8 Long Term Care Services Not Covered under the Policy [FN2] | ||
9 Provider/Facility Not Qualified under the Policy [FN3] | ||
10 Benefit Eligibility Criteria Not Met [FN4] | ||
11 Other | ||
[FN1]. The nationwide data may be viewed as a more representative and credible indicator where the data for claims reported and denied for your state are small in number. | ||
[FN2]. Example--home health care claim filed under a nursing home only policy. | ||
[FN3]. Example--a facility that does not meet the minimum level of care requirements or the licensing requirements as outlined in the policy. | ||
[FN4]. Examples--a benefit trigger not met, certification by a licensed health care practitioner not provided, no plan of care. | ||
S.C. Code Regs. ch. 69, 69-44, app E